Miccio, A. W. (2002). Clinical problem solving: Assessment of phonological disorders. American Journal of Speech-Language Pathology, 11, 221-229.
TAP
The topic of this article is the procedures for an assessment based on problem solving and heavily influenced by linguistics and phonetics. The intended audience is the student in Communication Disorders or the practicing clinician. The purpose is to inform the reader of the author’s opinion on how to give the most efficacious assessment possible.
Claims
- Use the referral source and the case history information to focus on the suspected problem. The assessment should be planned around the problem. It is a process that uses problem solving and requires critical thinking; like a puzzle. The assessment should be dynamic and does not have to be completed in a specific order.
- When a phonological disorder is suspected expressive and receptive language are tested, but receptive language should be tested first. Here, the most essential part of the assessment is getting an accurate characterization of the speech sound production problem.
- Understanding the family’s attitudes regarding the client’s communication disorder is important and can affect the course and ultimately the success of treatment.
- Sounds that the clinician finds to be stimulable will not require direct treatment. However, if the client becomes frustrated easily and the clinician needs some quick change because of this he/she can start with stimulable sounds for success.
Evidence
- Most professionals believe that it is important to learn as much information as possible during an assessment. Due to time constraints, it is more efficient to focus on the suspected problem while trying to attend this information. The information needed to be able to focus on the suspected problem can be obtained by reviewing the case history, questionnaire, and during parent interview. If the parents believe there is a problem, and are concerned enough to come to treatment, then the problem most likely exists. The assessment plan can always be changed if more problems arise, or because the clinician feels the need to. There are six problems the clinician should try and solve during the evaluation. Are the prerequisite behaviors for spoken language present? What is the current status of the speech and hearing mechanism? What are the current speech and language skills? What is the nature and severity of the disorder? What is the prognosis for change? What action is recommended? Those questions allow the clinician to remain focused and gather appropriate information. They form a guide for the clinician to think critically.
- If all components of the linguistic system have been found to be developing normally, and the phonological system develops accordingly, the client will have typical phonological development in their speech. But, if the client’s phonetic base grew without proper syntactic and lexical development, the speech of the client will show atypical phonological development. This is because the client will be struggling with limited sounds and syllable shape repertoire. Receptive language is tested first because some children will be hesitant to use expressive language with a clinician they do not know because they are afraid of being misunderstood. Receptive language tasks involve pointing and this allows the clinician to get information from a client that is hesitant. It is still important to try and get a language sample to observe a large number of the client’s skills in a short amount of time. This is an efficient way to assess prosody, fluency, voice quality, etc. To get an accurate characterization of the speech sound production problem, the clinician should complete a standardized picture naming test. A simple articulation test is more like a screening device because it does not provide information on connected speech, or the nature of the phonological problem. Some are culturally biased due to dialect. It is best to use play to elicit responses, conduct stimulability, and do a phonological analysis. This allows the clinician to design an intervention plan and judge severity.
- Parents can overact or under react to their child’s communication disorder. The way in which they respond to positive or negative information, the amount of support they are willing to give, and whether or not they will participate in therapy will help or hinder treatment. This is because they are the ones closest to the client and have a great impact on their behavior. A simple questionnaire can give the clinician this information.
- If a client is able to produce a sound with help, then it can be assumed that input and motor/linguistic output are both in tact. Studies have shown that these sounds can self-correct without any assistance. They will be acquired naturally. However, some clients can be easily frustrated or discouraged. The clinician is responsible for maintaining motivation. If this is the case, then the clinician should begin with simulable sounds that will come more easily for the client. Giving the client quick success could give them the motivation they need to work harder for sounds that are not simulable.
Connections
Text-to-self – This article reminds me of a project I completed for Diagnostics last semester. My partner and I had to take the current case history used in the MUSHC and revamp it to make a new one. There were so many things that came into it, it was overwhelming. It needed to be parent friendly all while making sure the best and most useful questions were asked. The article of this author said to use the case history to plan the assessment around the suspected problem. That means that the case history used needs to be a thorough and high quality one. I now appreciate how difficult that can be.
Text-to-text – Parts of this article reminds me of our text in 422. We learned about how to complete a phonological analysis. All the steps were broken down in class and we completed an analysis of our own. It was tedious work, but it was interesting to see patterns emerge. Knowing this process is a very important one when attempting to learn about a client’s phonological development. It is something that I have been able to learn that will directly relate to practice. Not all of the skills we learn in class are that easy to generalize to therapy.
Text-to-world – As with all the other assessment articles, this one will be helpful when I begin doing my own assessments. It allows me to see other professional’s opinions of how assessment should be done. I can sift through it to find what will be useful to me and then adapt that to my own evaluations. It is very important to have a well thought out plan for assessment. There is a lot of information that needs to be assessed in a very short amount of time. Learning these things will make me more efficient when the time comes.
